Individual
MRS. TIFFANEY SHAREE RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
1 TAMPA GENERAL CIR, TAMPA, FL 33606
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN9361516
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024717300
—
FL
01
—
Y9XCL
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/13/2010
Last updated
03/22/2021
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